A typology for provider payment systems in health care

Jegers, Marc; Kesteloot, Katrien; Graeve, Diana De; Gilles, Willem

doi:10.1016/s0168-8510(01)00216-0

Cited by 183 publications

(173 citation statements)

References 18 publications

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“…Reimbursement systems are usually described along two dimensions (Jegers et al, 2002): whether the system is retrospective or prospective and whether the system is activity-based or fixed. All seven countries applied prospective payment systems but some with elements of cost compensation.…”

Section: Healthcare Systems and Utilization Ratesmentioning

confidence: 99%

Acute Myocardial Infarction, Use of Percutaneous Coronary Intervention, and Mortality: A Comparative Effectiveness Analysis Covering Seven European Countries

et al. 2015

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Percutaneous coronary interventions (PCI) on acute myocardial infarction (AMI) patients have increased substantially in the last 12-15 years because of its clinical effectiveness. The expansion of PCI treatment for AMI patients raises two questions: How did PCI utilization rates vary across European regions, and which healthcare system and regional characteristic variables correlated with the utilization rate? Were the differences in use of PCI associated with differences in outcome, operationalized as 30-day mortality? We obtained our results from a dataset based on the administrative information systems of the populations of seven European countries. PCI rates were highest in the Netherlands, followed by Sweden and Hungary. The probability of receiving PCI was highest in regions with their own PCI facilities and in healthcare systems with activity-based reimbursement systems. Thirty-day mortality rates differed considerably between the countries with the highest rates in Hungary, Scotland, and Finland. Mortality was lowest in Sweden and Norway. The associations between PCI and mortality were remarkable in all age groups and across most countries. Despite extensive risk adjustment, we interpret the associations both as effects of selection and treatments. We observed a lower effect of PCI in the higher age groups in Hungary.

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Section: Healthcare Systems and Utilization Ratesmentioning

confidence: 99%

Acute Myocardial Infarction, Use of Percutaneous Coronary Intervention, and Mortality: A Comparative Effectiveness Analysis Covering Seven European Countries

et al. 2015

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“…1,2 Such cost-containment measures may be embedded in health sector reforms that apply various strategies such as making hospitals autonomous, implementing provider-purchaser split 3,4 and reforming the provider payment system. 2,5 The literature provides many forms of payment methods, including salary, budgetary transfers, fee-for-service, case-based/diagnosis-related-group (DRG), capitation payment, pay-for-performance and mixed methods.…”

Section: Introductionmentioning

confidence: 99%

A narrative synthesis of illustrative evidence on effects of capitation payment for primary care: lessons for Ghana and other low/middle-income countries

Andoh-Adjei¹,

Spaan²,

Asante³

et al. 2017

Ghana Medical Journal

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SUMMARYObjective: To analyse and synthesize available international experiences and information on the motivation for, and effects of using capitation as provider payment method in country health systems and lessons and implications for low/middle-income countries. Methods: We did narrative review and synthesis of the literature on the effects of capitation payment on primary care. Results: Eleven articles were reviewed. Capitation payment encourages efficiency: drives down cost, serves as critical source of income for providers, promotes adherence to guidelines and policies, encourages providers to work better and give health education to patients. It, however, induces reduction in the quantity and quality of care provided and encourages skimming on inputs, underserving of patients in bad state of health, "dumping" of high risk patients and negatively affect patient-provider relationship. Conclusion:The illustrative evidence adduced from the review demonstrates that capitation payment in primary care can create positive incentives but could also elicit un-intended effects. However, due to differences in country context, policy makers in Ghana and other low/middle-income countries may only be guided by the illustrative evidence in their design of a context-specific capitation payment for primary care.

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“…Under PPS, a predetermined, …xed amount of resources is paid for the service. The rationale is that reimbursement based on ex-ante costs prevents health care providers from giving unnecessary care (Jegers et al, 2002). In the U.S., the use of PPS has been extended from hospitals to the nursing home sector in 1997 through the Balanced Budget Act.…”

Section: Introductionmentioning

confidence: 99%

Implications of global budget payment system on nursing home costs

2014

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Pressure on health care systems due to the increasing expenditures of the elderly population is pushing policy makers to adopt new regulation and payment schemes for nursing home services. We consider the behavior of nonpro…t nursing homes under di¤erent payment schemes and empirically investigate the implications of prospective payments on nursing home costs under tightly regulated quality aspects. To evaluate the impact of the policy change introduced in 2006 in Southern Switzerland -from retrospective to prospective payment -we use a panel of 41 homes observed over a 10-years period (2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010). We employ a …xed e¤ects model with a time trend that is allowed to change after the policy reform. There is evidence that the new payment system slightly reduces costs without impacting quality.

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A typology for provider payment systems in health care

Cited by 183 publications

References 18 publications

Acute Myocardial Infarction, Use of Percutaneous Coronary Intervention, and Mortality: A Comparative Effectiveness Analysis Covering Seven European Countries

Acute Myocardial Infarction, Use of Percutaneous Coronary Intervention, and Mortality: A Comparative Effectiveness Analysis Covering Seven European Countries

A narrative synthesis of illustrative evidence on effects of capitation payment for primary care: lessons for Ghana and other low/middle-income countries

Implications of global budget payment system on nursing home costs

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